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Step 2 CK > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Gastric lavage can be done up to ____ hours?

A

2

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2
Q

Gastric lavage removes _____ % at 1 hour

____ % at 2 hours

A

50% pills 1 hour

15% pills 2 hours

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3
Q

_____ is always the wrong answer in the emergency apartment when it comes to toxic ingestion?

A

Ipecac (delays admin of antidotes)

Cathartics like sorbitol (speeding up GI transit time does not block absorption)

Fluids + Diuretics- does more harm (pulm edema)

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4
Q

When might gastric lavage be dangerous?

A

AMS - can cause aspiration

Caustic Ingestion- causes burning of esophagus and oropharynx

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5
Q

best initial management of altered mental status of unclear etiology in ED is?

A

opiate antagonist and glucose

Naloxone and glucose work instantaneously and have no adverse effects

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6
Q

Toxicity of acetaminophen occurs with ___ - ____ grams. Fatality may occur with ____ - ____ grams?

A

8-10: toxic

12-15: fatal

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7
Q

If a clearly toxic amount of acetaminophen has been ingested (8-10 grams) what do you give?

A

N-acetylcysteine

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8
Q

If overdose of acetaminophen was over 24 hours ago what can you do?

A

no therapy

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9
Q

If amount of acetaminophen ingestion is unclear- what should you do?

A

get a drug level

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10
Q

Is charcoal contraindicated with N-acetylcysteine?

A

NO

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11
Q

Tinnitus, resp alkalosis and metabolic acidosis are the key to diagnosing?

A

ASA toxicity

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12
Q

Treatment for ASA tox?

A

Alkalinize urine- increases rate of ASA excretion

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13
Q

When you reverse benzo ingestion, you remove suppression of _____ drug toxicity?

A

TCA (Benzos have a protective effect on TCA toxicity)

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14
Q

Treatment of TCA toxicity?

A

sodium bicarb. Bicarb protects heart against arrhythmia.

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15
Q

Does bicarb increase urinary excretion of TCA as it does for ASA?

A

NO

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16
Q

Most common cause of death in fires?

A

CO poisoning

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17
Q

CO poisoning presents like what other pathology?

A

anemia (functionally the same thing)

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18
Q

What type of blood gas would you see with CO poison?

A

carbon monoxide prevents release of oxygen to tissues so you see a lactic acidosis

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19
Q

Most accurate test for CO poison?

A

level of carboxyhemoglobin (routine oximetry will be falsely normal)

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20
Q

treatment for CO poison?

A

100% O2. severe treated with hyperbaric O2.

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21
Q

Treatment when CO poision presents with CNS symptoms, cardiac symptoms, metabolic acidosis (any of these)?

A

hyperbaric oxygen

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22
Q

What drugs can cause oxidized hemoglobin (methemoglobinemia) (Hgb locked into the ferric state)?

A

benzocaine, other anesthetics, nitrites, nitroglycerin, dapsone

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23
Q

CO poison: blood is abnormally _____

Methemoglobinemia: blood is abnormally ____

A
  • Red

- Brown

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24
Q

Best test for methemoglobinemia

A

methemoglobin level. PO2 is normal on blood gas!

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25
Q

Best initial therapy for methemoglobinemia? Most effective therapy?

A
  • 100% oxygen

- Methylene blue

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26
Q

how does methylene blue work?

A

decreases half life of methemoglobin

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27
Q

cyanosis + normal PO2 =

A

methemoglobinemia

28
Q

What is the first step in management of a patient with nerve gas poisoning?

A

Atropine

29
Q

what is the antidote for organophosphate poisoning?

A

pralidoxime

30
Q

Why does hypokalemia predispose to digoxin toxicity?

A

potassium and digoxin compete for binding at the same site on Na/K ATPase. When less K binds, more Dig binds

31
Q

Most accurate test for dig toxicity? Best initial test for suspicion of dig toxicity?

A
  • Dig level

- potassium (look for hyperkalemia) and EKG

32
Q

EKG findings in DIG toxicity?

A

downsloping of ST segment

33
Q

indications for Dig binding antibodies?

A

CNS and cardiac involvement

34
Q

Best initial test for lead toxicity? most accurate?

A

increased level of free erythrocyte protoporphyrin. lead level is most accurate.

35
Q

most accurate test for sideroblastic anemia?

A

Prussian blue stain

36
Q

Treatment of methanol and ethylene glycol toxicities?

A

fomepizole (inhibits alcohol dehydrogenase) and dialysis

37
Q

ocular toxicity is a presentation of?

A

methanol poison (found in wood alcohol, cleaning solution, paint thinner)

38
Q

renal toxicity and envelope shaped oxalate crystals?

A

ethylene glycol

39
Q

Serum Osm =

A

2XNa + BUN/2.8 + Glucose/18

40
Q

What causes death in snake bites?

A

hemolytic toxin: hemolysis and DIC

Neurotoxin: respiratory paralysis

41
Q

Spider bite with abdmonial pain, hypocalcemia?

A

black widow

42
Q

spider bite with local skin necrosis, bullae, blebs

A

brown recluse

43
Q

treatment for brown recluse bite

A

debridement, steroid, dapson

44
Q

treatment for black widow

A

calcium, antivenin

45
Q

Treatment for dog, cat, human bites?

A

amoxicillin/clavulanate

Tetanus vaccination if more than 5 years since last injection

46
Q

When is rabies vaccine indicated?

A

animal has AMS/bizzare behavior

attack was unprovoked by a stray that cant be observed/diagnosed

47
Q

Management of large hematoma?

A

intubation, hyperventilation, (decreases PCO2-constricts cerebral circulation), mannitol, drainage

48
Q

only clear indications for stress ulcer prophylaxis with PPI are?

A

head trauma, burns, endotracheal intubation, coagulopathy with resp failure

49
Q

What fluid should you choose for burn victims?

A

ringers lactate

50
Q

Fluid replacement equation

A

4ml X %BSA burned X weight in kg

51
Q

What prophylactic treatment for infection is typically given for burn victims?

A

topical antibiotic (silver sulfadiazine)

52
Q

most common cause of death from hypothermia? best initial test in hypothermic patient?

A

cardiac arrhythmia

EKG

53
Q

What characteristic finding is seen on EKG for hypothermia?

A

I waves. QRS hits ST segment

54
Q

What are 2 answers that are ALWAYS wrong for drowning?

A

antibiotics

steroids

55
Q

When is “precordial thump” the answer?

A

very recent onset of cardiac arrest with no defibrillator available. (You saw it happen)

56
Q

best initial management of all forms of pulselessness?

A

CPR

57
Q

Only 2 types of arrhythmias without a pulse where difibrillation or unsynchronized cardioversion should be used?

A

VT and VF

58
Q

Patients with asystole should receive?

A

Epi or vasopressin

59
Q

How to diagnose PEA?

A

look for normal EKG and no pulse

60
Q

when is heparin necessary vs not before starting a patient with afib on warfarin

A

only need to use heparin when there is a current clot in the atrium

61
Q

Do vagal maneuvars convert afib?

A

no

62
Q

SVT with alternating VT
SVT that gets worse with dilt or digoxin
delta wave

these are signs of?

A

WPW

63
Q

What anti-arrhythmics should you use if WPW is currently presenting with an arrhythmia?

A

Procainamide or amiodarone

64
Q

What drugs are dangerous in WPW? why?

A

Dig and CCB- block the normal AV node and force conduction into abnormal pathway

65
Q

Multifocal atrial tach is associated with?

How do you ID it on EKG?

A

COPD

at least 3 diff P-wave morphologies

66
Q

what test would you do to determine risk of arrhythmia recurrence following an MI?

A

Echo- Assess LV EF

Step 2 CK (26 decks)

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